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S Step 4 Medically Screen All Userstep 4 Medically Screen All Users
Medical Evaluation of Health CareEvaluation of Health Care
Medical Some restrictions (e.g., type of respirator or
Workers workload) for those with moderate
Workers to Determine Fitness toto Determine Fitness to
Wear Respirators
Wear Respirators impairment.
No respirator wear for individuals
with severe impairment.
Respirators place several physiological stresses
on wearers—stresses that particularly involve
the pulmonary and cardiac systems. How- NOTE: Some respirators have a latex component
ever, respirators typically used by health care and should not be worn by those who are allergic
workers are generally lightweight, and the to latex.
physiological stresses they create are usually Because most health care workers wear the very
small. Therefore, most workers can safely light, disposable half-mask respirator, CDC
wear respirators. Guidelines [CDC 1994] recommend that a health
questionnaire be the initial step in the evaluation.
OSHA has exempted the respirator require- If results from this evaluation are essentially nor-
ments of the current 1910.134 for prevention of mal, the employee can be cleared for respirator
occupational transmission of TB in health care wear. Further evaluation, possibly including a
settings. Current OSHA regulations (29 CFR directed physical examination and/or spirom-
1910.139) state that workers should not be as- etry, should be considered in cases in which po-
signed tasks requiring respirators unless they tential problems are suggested on the basis of the
have been determined to be physically able to questionnaire results.
perform the work while using the equipment.
The regulations also note that a physician Medical reviews of this issue including practical
should determine the criteria on which to base recommendations from several groups, including
this determination. the American National Standards Institute (ANSI),
AIHA, and the American Thoracic Society (ATS)
No general consensus exists about what ele- are included in the references [ANSI 1992; AIHA
ments to include in medical evaluations for 1993; American Thoracic Society 1996]. Sample
respirator use in general industry. Some institu- questionnaires that have been used in health care
tions use only a questionnaire as a screening settings are in Appendix E.
tool; others routinely include a physical exami-
nation and spirometry; and some include a OSHA has issued a compliance memorandum
chest X-ray. No generally accepted criteria exist (see Appendix B) and is developing a separate
for excluding workers from wearing respirators. standard which will address the medical
Specifically, no spirometric criteria exist for ex- evaluation issue. Health care administrators
clusion. However, several studies have shown should be alert to developments in this area.
that most workers with mild pulmonary func-
tion impairment can safely wear respirators. If a health care facility uses respirators for
Thus, some journal articles and organizations worker protection against other regulated
recommend the following: hazards (e.g., formaldehyde, ethylene oxide,
etc.), then a respirator program must be
Medical clearance for those with implemented for these hazards under 1910.134
normal or mild pulmonary function including medical evaluations by a physician
impairment. or other licensed health care professional.
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